A group of nurses at Texas Health Presbyterian has come forward with a very different picture of what happened when Liberian Ebola patient Thomas Duncan arrived at the hospital with Ebola-like symptoms on September 28th. If true, the allegations are certainly unsettling.
In an unusual move, the nurses spoke anonymously to the media, conducting a blind conference call in which none of the participants were identified.
After arriving at the emergency room with a high fever and other symptoms of the disease , the nurses said the patient was kept in a public area, despite the fact that he and a relative informed staff that he had been instructed to go to the hospital after contacting the Centers for Disease Control in Atlanta to report a possible case of Ebola.
The nurses said the patient was “left for several hours, not in isolation, in an area” where up to seven other patients were. “Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,” they alleged.
Duncan’s lab samples were sent through the usual hospital tube system “without being specifically sealed and hand delivered. The result is that the entire tube system … was potentially contaminated,” they said.
The statement described a hospital with no clear rules on how to handle Ebola patients, despite months of alerts from the Centers for Disease Control and Prevention in Atlanta about the possibility of Ebola coming to the United States.
“There was no advanced preparedness on what to do with the patient. There was no protocol. There was no system. The nurses were asked to call the infectious disease department” if they had questions, but that department didn’t have answers either, the statement said. So nurses were essentially left to figure things out on their own as they dealt with “copious amounts” of highly contagious bodily fluids from the dying Duncan while wearing gloves with no wrist tapes, flimsy gowns that did not cover their necks, and no surgical booties, it alleged.
The charges come on the same day as news that a second healthcare worker has tested positive for Ebola. Frieden said public health officials should prepare for the worst, saying that it is likely that more cases will emerge.
The CDC Director issued a series of statements yesterday admitting that the agency was slow in responding to the crisis. Frieden backtracked on statements that many nurses interpreted as throwing the nurses involved under the bus. The agency is reassessing its guidance on the disease.
Nurses and their supporters took to Twitter to defend the nurses involved.
Note: You can read the CDC’s original guidance to health care workers in Frieden’s THCB blog post here.
Update : Revised guidelines call for extra precautions to be taken to cover exposed skin, second layer of gloves.
If you are a nurse involved in the care of a patient at Texas Health Presbyterian, we’d like to hear your side of the story. E-mail us. We’re also interested in hearing from other nurses around the country. Has your hospital established procedures and guidelines for dealing with potential Ebola cases?
Pick up the story from the Dallas Morning News here
Categories: Uncategorized
This is a really good tip particularly to those fresh to the blogosphere.
Short but very accurate information… Thanks for sharing this one.
A must read article!
Vendors know that they are not to sell medical devices without FDA approval. How it came to be that EHR, CPOE, and CDS are being used to diagnose and treat disease without approval by the FDA is a matter for investigation.
Those who have allowed this, giving the vendors of EHRs a pass from oversight, have Mr. Duncan’s blood on their hands.
The facts indicate that the EHR was true to form, causing errors that would never have occurred with the highly evolved safety net that was replaced by the user unfriendly, time consuming, flawed EHR.
What makes John think that Kincannon was speaking for the Tea Party? Oh, he made that up. …and he also made up the claim about his annoyance over the comments being made and how the thread refuses to die. If he wanted the thread to die he would have not written such nonsense.
We wait to hear why what Senegal did to become Ebola free is so wrong.
This thread refuses to die. Every day I delete notices from my inbox for yet another bunch of comments at this post. Most are spam (which keep the blog moderators busy) but many are just ongoing yammering. Please, folks, put a sock in it. Give it a rest. Some here may have a bright futures asTea Party activists, like South Carolina’s Todd Kincannon.
http://aattp.org/pro-life-tea-party-christian-todd-kincannon-execute-all-ebola-patients-screenshots/
I came across a new twist on an old axiom — You can show some folks the facts but you can’t make them think.
If the shoe fits… you know the rest.
The death rate from this strain of Ebola is now said to be around 70% and that doesn’t count the deaths that never make it to be counted.
We will be able to judge how good American care is when we see how many of those that get Ebola die. Hopefully the number will not be statistically significant.
What country has put in more dollars than the US in trying to find a vaccine and/or a cure? Can you tell us the answer?
What was wrong with Duncan’s care? What was wrong was the care for others around him. That is a problem when something new suddenly appears and the experts stay in DC.
Gina, you must love the job we are doing today as immigrants enter and even when stopped are left free to go. Silly way you seem to be looking at things.
Ellis Island was for the poor folk coming in from Europe. Not silly as over 12 million people were processed there and held if they were found to carry infectious disease. Others from Europe came with more finances and were processed differently, but health concerns were a priority.
Before 1954 I wonder how many Canadians per year came to the US and (per year) how many people actually immigrated to the US through Canada and Mexico without being evaluated. Are you able to educate us on these facets of immigration?
Did you not realize who went through Ellis Island and that medical checks were done?
It wasn’t till a lot later that our immigration policy changed and we started to discriminate against Europeans and the like that were educated.
Too bad Duncan was wrong in his assessment of “getting good care” in the U.S.
Not all Immigrants went through Ellis Island (stop using such silly stuff as an example) – a lot of Immigrants got off in Mexico and Canada and just walked across. I rather we track them, then scare them into hiding and sneaking in.
Funny how NO ONE CARED about ebola (even though it’s been on TV every night since August) until it landed here. Keep in mind the the U.S. outbreak started in Texas at a “supposed” state of the art hospital. If I knew we had an ebola patient – I would have read up on everything I could about it after seeing how those nurses in West Africa had been suited up and sprayed down—-then have our hospital tell me to just put on a gown and mask——no way would I have gone in there. Common sense people.
Stop making Ebola political! Get a grip. Like that would really stop people from coming to the US. It would be even more alarming knowing people were sneaking in and not be able to track them. Let’s stop all flights out of Texas or anyone leaving or transporting things from Texas. Does that sound logical?
Peter1 writes: “Tell you what Allan, if Canada has an epidemic of Ebola I’ll support a travel ban.”
Typical low level thinking of leftist ideology on many fronts.
Tell you what Allan, if Canada has an epidemic of Ebola I’ll support a travel ban.
You totally miss the point. I provided a methodology and you provided an editorial that is talking about the rhetoric being used. That is a typical ideological response by one that doesn’t have an answer.
What is wrong with the methodology I presented? What is wrong with the methodology used by Senegal and Nigeria that are becoming Ebola free?
You don’t have an answer so you post an editorial that is not on point.
We don’t know if we will have another case or not. What we do know is that one case has caused hundreds to be cautioned, two nurses to be hospitalized, a large hospital being compromised, an airline to be placed in jeopardy plus placed with a lot of costs, an airline industry that could be badly hurt along with the downstream effects to the economy and probably in the millions of dollars in costs for one patient.
Maybe no more carriers of Ebola will enter again and that will prove that the caution was unnecessary *retrospectively*, but if it turns out that more enter we have to multiply the negative effects by the number of entries to provide an approximate cost which would be at the lower end of the spectrum.
A timely article Allan.
http://www.cnn.com/2014/10/17/us/ebola-provocative-quotes/index.html?hpt=hp_t1
Peter1, a well known and well practiced proven methodology is not political. What is political are your accusations.
What is the evidence that the above is not the best way to protect this nation? You don’t have any.
The reason Obama has decided to do what he has done is for political reasons and that might be rational, but his rational that we don’t want to make the people feel trapped is not well grounded for the nations surrounding the hotspots have sealed their borders and two will soon be considered Ebola free.
We must protect our resources to protect our citizens and to protect our efforts to aid these nations.
Those nations that have sealed their borders have done more to end the Ebola outbreak than any of our efforts so far.
All that I am saying is based upon logic and common sense, but sometimes the ideological driven prefer dreams and their religion of the left to reality.
“Politics is dominating common sense and it is dulling the intellect of those that suck it up.”
“This has nothing to do with politics.”
?
Peter1, it is not the true conservative right that requires zero risk rather the left that almost always uses anecdotes to prove a point. Zero risk cannot be obtained, but one can attack the bulk of the risk and that is what it seems you fail to understand.
This has nothing to do with politics. It only has to do with common sense. The third world nation of Senegal will shortly be considered Ebola free followed by the third world country of Nigeria. How did they do that with their third world technology?
They sealed their borders and intensively followed every one in contact with the virus.
These third world nations see to have something we don’t. Common Sense!.
Allan, you and the frantic Right (pre Nov 4) are calling for travel restrictions based on nothing but location, location, location – no matter the risk.
How do you know what risk is posed by the Ebola State – Texas? Don’t you want zero risk?
Bobby, it appears that Duncan knew he was probably infected and what did he do? Where is the best technology and care to prevent death from this disease? The US.
Duncan a trained individual hopped a plane to the US. People that are dying will do a lot to remain alive.
Peter1, we are not discussing persons that have little to no risk. We are talking about real risk and real lives. As stated below Doctors Without Borders has lost 9 of their staff and have 16 infected.
You might be right John that there is a polar vortex because I am compelled to agree with you. I think that some of the louder voices don’t disagree either except rightfully they believe the border should be shut/controlled with regard to non American citizens from the hotspots of those nations. We have the facilities to manage Ebola once we get our act together.
Look at the havoc one Ebola patient caused. Disruptions to the airline industry and all the industries downstream can have a similar effect. School closures in the areas. Hundreds of people in isolation. A major hospital’s ER shut down because of fear and nursing shortages. What happens to those patients that require intensive care when they become sick with other diseases and there are inadequate facilities to treat them?
Take note that this disease though controllable in this country needs to be limited as much as possible and that means control of the borders. Also take note that Doctors Without Borders is a trained group and they have lost 9 members to Ebola and have another 16 members of their staff infected. The answer is simple. We should not panic but we should control entry to those in Ebola ridden areas and isolate anyone who might be infected. (isolation and quarantine are different)
Governor Rick Perry is now calling for a travel ban. I agree, we should not let Texans travel outside the state since their medical system is incapable of containing their “outbreak”.
Barricades should be placed at all roads crossing state lines, air travel should be blocked from leaving texas and train service outside the state ended. Since cows may contract the disease no Texas beef should be sold outside the state.
Better to take necessary precautions than panic.
Got to blame the Wright brothers
You left off the golf club and the cigarette.
That is in the coverage machine. The coverage asks the usual pundits the usual blame questions and they get the comments for the momentary news cycle.
There may be a polar vortex in Hell because I am compelled to say say Thank you to National Review Online and Shep Smith of Fox News. Anyone familiar with my politics (unreconstructed Sixties Liberal) knows I have a deep-rooted antipathy for both. But it’s only right to recognize when they get something right.
The link is easy to find. Read for yourself as they point out something blindingly clear:
Despite the fever-pitch nature of televised Ebola coverage, there are exceptions. On Fox News, anchor Shepard Smith went out of his way to provide context for a reporter’s conclusion that Ebola was causing “widespread panic” across the country.
“I think we both know there’s no widespread panic across the country,” Smith responded before turning to the camera to address the TV audience directly.
“You should have no concerns about Ebola at all. None. I promise,” Smith said. “Do not listen to the hysterical voices on the radio and the television or read the fear-provoking words online. The people who say and write hysterical things are being very irresponsible.”
But as for his show, Smith said, “it’s not worth the ratings and it’s not worth the politics” to say Ebola is an imminent danger when the day might come when a real panic hits.
“We do not have an outbreak of Ebola in the United States. Nowhere. We do have two health-care workers who contracted the disease from a dying man. They are isolated. There is no information to suggest that the virus has spread to anyone in the general population in America. Not one person in the general population in the United States.”
Would that more of Smith’s colleagues in the media followed his lead. Concern is one thing, but raw, unreasoning fear is something that must be combatted as a public service.
Since the U.S. can’t get their act together, perhaps we should find some real health care professionals (from Africa) who are equipped to work with ebola patients, to train our U.S. staff.
Since September all the nightly news channels have been showing how “suited” up the African healthcare workers are and how something as simple as washing your hands, etc – can kill the virus.
Why the nurse would board a plane – even with a low grade fever – after having worked around Mr. Duncan, I don’t care what the CDC told me – I would not expose my family or anyone else.
I have little faith in healthcare workers in Texas right now. I would have read everything on ebola and what precautions to take for my own safety, then alerted the news if not given the correct protective gear required. The whistle blower and others, need to accept some blame here.
Common sense, people!
Above is lame attempt at a smiley.
:>D
http://www.bgladd.com/ObolaAirForce1.jpg
peter1: “although having the CDC there would have helped.”
If you read my comments you would see that is what I expected of the CDC. I also expected them to make sure the hospital was prepared. My understanding is that this is a good hospital with good staff. The CDC told the patient to go to the hospital and should have notified the hospital in advance along with checking on needs. I would have strongly considered sending the CDC to the hospital and also considered transferring the patient to Emory or the hospital in Nebraska.
Instead the CDC made all sorts of comments that tried to meet the political needs of the moment. It sounded as if they were flipping coins.The CDC contradicted itself and the President while continually backtracking. The way to stop panic is to get ahead of the situation.
I do not believe we will have an epidemic of ebola in this country. We might have sporadic outbreaks. I want to reduce those outbreaks as much as possible so that we do not have to impose isolation or quarantine on so many Americans. I also want to reduce the number of hospitals involved because hospitals are not overstaffed and this one patient took too many of the staff away from their other duties. The hospital will have difficulty hiring more staff because of ebola. That means we risk having areas not adequately covered for emergency medical services. Thirdly the costs for one patient are horrendous. Finally this has economic impact. My bet is the airline industry will suffer tremendously if we find another patient with ebola on a plane and this has further impact on other sectors of the economy. The fears do not have to be rational to cause the economic impact I am talking about. Decisions that appear political even if correct decisions exacerbate the problem and in this case the decisions were either openly political or lacked a sense of mission
My views on this topic are not political. They are simply practical and represent common sense.
“The first link showed the equipment to be used for level 4 pathogens.
The second link showed that ebola was considered a level 4 pathogen.”
You said the hospital did NOT have the right gear. The hospital said they had what CDC prescribed – which I assume was the “level 4” equipment.
Just because a nurse has trouble getting used to the equipment is not the fault of CDC – although having the CDC there would have helped.
You argue in circles like the March Hare.
Seigel is taking an all or none view of the situation. I have heard him before and he becomes flummoxed when others explain a ban need not exist as charter flights and military aircraft could be used. Isolation could also be a solution and is presently being used in the US with American citizens that have become exposed to the virus.
No one can predict the future so one should be cautious and recognize that each case causes many Americans to face isolation, hospitals to close their doors and send ambulances elsewhere along with immense amounts of spending that could be better used in fighting the disease.
“Sadly, it has reached the point where we will not feel safe unless we ban travel to and from Liberia, Sierra Leone, and Guinea. The reason this is a sad moment is that there is a good chance it could interfere with the flow of health care and resources to and from these countries. Not only that, but, historically, when a country suffering from a growing epidemic has felt cut off from the rest of the world, the fear quotient has risen, and people afraid of the contagion have attempted to flee. Unfortunately, when people hastily attempt to escape imposed restrictions, they tend to take fewer precautions, which increases their chances of catching the dreaded disease.
But first and foremost, although we are members of the world health community, we must worry about our own public psyche here in the United States. If our leaders can’t give us a sense that we are protected, we must achieve it by imposing a ban.”
– Marc Seigel, MD, National Review
Did you not link to the CDC recommendations that I posted?
The first link showed the equipment to be used for level 4 pathogens.
The second link showed that ebola was considered a level 4 pathogen.
The article showed how the nurses had to keep catching up. Even their necks were not initially covered. It is not easy to remove a contaminated gown. All of this takes practice and thought, but there are lots of distractions when one is faced with a dying patient.
“I don’t understand what you are trying to point out.”
You said:
“The protective gear is not made for this type of infection. The gear is not made for this degree of protection nor is the supervision.”
I linked to the hospital statement that said the gear they used was CDC prescribed for eboa.
Why is it so hard for you to understand the obvious?
Absolutely! He is so right.
That is a reason we are a Constitutional Republic. That is the difference between the American and the French revolutions. The masses despite their education, class, or whatever in a democracy can with 51% of the vote, vote the other 49% into slavery.
In any event thank you for bringing up his name and thoughts which are somewhat buried in history.
Peter1, I don’t believe this was a political plot. The editors have been quite open from what I have seen so I suspect it has nothing to do with politics.
In any event I am glad you were able to get the CDC links I sent.
Peter1, my response to you that provided the CDC’s own methods of handling level 4 pathogens is still being held by the moderator for some unexplained reason.
I don’t understand what you are trying to point out. I am sure the nurses did the best they could with their training and the facilities available. If you note some of the earlier actions were not consistent with how level 4 pathogens are handled by the CDC. You will also note that there was a progression in safety provisions.
Ebola is new or relatively so to the staff at that hospital. I believe the CDC should have been more proactive and careful.
When nurses become contaminated it causes that particular hospital to be less available to the community. It also drains our resources. That is why I believe we should do everything possible to prevent ebola from entering the country. If we cut down potential risk by 50% then 50% less money will be sent and 50% less hospital doors would be closed.
“Why was my comment placed on moderation”
I have found that more than one link puts you in moderation.
Unless it is a liberal plot, better look closer.
Yeah. But it has nothing to do with her elsewhere recent assertion that Epic EHR caused the Texas Duncan Ebola death. Moreover, her claims (~13.00-ish) regarding the safety of paper charts is overstated.
It was! To illustrate that public institutions are not value neutral, but depend on the wish of the public (the masses).
Why was my comment placed on moderation when it was on topic and even provided two CDC sites that demonstrated what type of precautions needed to be taken?
Allan says:
October 16, 2014 at 7:23 am
Peter1 writes: “Show me. And whose politics”
Plain generic politics.
It is stupidity when one places national security and the security of the American people at jeopardy because of politics.
You want proof. I provided some below in a list that states some of the errors, but the real proof is at the CDC where one can read how level 4 pathogens are supposed to be handled.
http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf
http://www.cdc.gov/training/quicklearns/biosafety/
Those are the rules the CDC sets for itself and they are dealing mostly with pathogens that are in petri dishes, not generally in patients that are vomiting and excreting virulent pathogens through every orifice of their bodies.
We are quarantining Americans now, but won’t quarantine those coming from ebola infected areas.
I don’t give a hoot about politics when national security is the issue. Apparently from some of what I read that is all what some think about when they try and bend the news.
We have had experience in quarantine. Until 1954 immigrants would go through Ellis Island. Why do you think that was done? Do you think they were throwing a party?
REPLY
Why is this above comment awaiting moderation?
Allan says:
Your comment is awaiting moderation.
October 16, 2014 at 7:23 am
Peter1 writes: “Show me. And whose politics”
Plain generic politics.
It is stupidity when one places national security and the security of the American people at jeopardy because of politics.
You want proof. I provided some below in a list that states some of the errors, but the real proof is at the CDC where one can read how level 4 pathogens are supposed to be handled.
http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf
http://www.cdc.gov/training/quicklearns/biosafety/
Those are the rules the CDC sets for itself and they are dealing mostly with pathogens that are in petri dishes, not generally in patients that are vomiting and excreting virulent pathogens through every orifice of their bodies.
We are quarantining Americans now, but won’t quarantine those coming from ebola infected areas.
I don’t give a damn about politics when national security is the issue. Apparently from some of what I read that is all what some think about when they try and bend the news.
We have had experience in quarantine. Until 1954 immigrants would go through Ellis Island. Why do you think that was done? Do you think they were throwing a party?
REPLY
“Peter1, you demonstrate pure ignorance. Nurses are trained to prevent transmission of disease to the patient and to a lesser degree to themselves and others. Others down the chain even have less training. The protective gear is not made for this type of infection. The gear is not made for this degree of protection nor is the supervision.”
I guess my link was for you Allan, not V-I-K.
http://www.star-telegram.com/2014/10/15/6202585/ebola-risk-cdc-looking-for-passengers.html
“• When Mr. Duncan returned to the Emergency Department (ED), he arrived via EMS. He was moved directly to a private room and placed in isolation. THD staff wore the appropriate personal protective equipment (PPE) as recommended by the CDC at the time.”
V-I-K, what about 1980, 1990, 2000, 2010? Been much of an increase since then?
Deborah Peel TED backstory.
About twenty minutes.
Pretty unsettling.
http://youtu.be/rRkGTNnEHk0
We’ll be featuring a post on the EHR story from Deborah & her Patient Privacy Rights group a little later this morning, should be coming in shortly …
Saurabh, thank you, but it doesn’t seem to me that the address you provided is the address you wanted me to read.